Supervision as Strategy: Developing People, Strengthening Practice

Why a Shared Framework Beats the Luck of the Draw

Fieldwork (the supervised hours before certification) is where most behavior analysts are made. It is also where many of them get lost. The same program can look very different from one trainee to the next. What a trainee learns can rest on one thing: which supervisor they land with. Elevate Behavior Services set out to take that luck out of the system. They run an ABA practice (applied behavior analysis for autism) with two sites in Tennessee.

The practice grew fast. It opened in 2018 in about 2,400 square feet. In 2023 it moved into a 9,000 square foot space for kids ten and under. Later it opened a second site for teens and older clients. About 57 staff now work across the two buildings, and 11 of them are BCBAs (board certified behavior analysts). Ten BCBAs have come up through the program and joined the team. Four of them passed the exam and joined in the past year.

Structure helps the supervisors as much as the trainees. A shared roadmap means less planning from scratch each month. Every BCBA starts from the same page. Every resident knows what comes next and can track their own progress. The team caps the program at about four residents at a time. There is a waiting list, and they keep the cap on purpose. Burnout is the risk they are trying to head off.

So we called our program the Residency Program.

From the talk — Sarena Cambrea

The Three Residency Levels: Earned, Not Timed

Every resident starts with a self-rating on the exam content. Then they move through three levels. Levels are not about time served. They turn on what a resident can show.

Level one runs at least 100 hours. The work is mostly watching BCBAs and being watched in turn. Residents write narrative observations and build graphs. They start visual analysis (reading graphs to judge progress). They also review assessments and many teaching curricula. Two things are off limits at this level: making program changes and giving feedback to staff.

Level two adds supervised case work. The resident helps run a case with a BCBA in the room, and their BCBA assigns which cases. They draft mock treatment plans (the written plan of client goals) and summaries. They take a bigger role in assessment, often starting with the parent questionnaire part. They help pick the assessment tools and learn the data software the team uses.

Level three looks close to independent work. Residents handle case management with no BCBA present. Oversight stays in place through set tasks and follow up. They help write treatment plans and summaries, with BCBA approval. They run assessments, write goals, and choose how progress gets measured. They also give feedback to staff for the first time. That feedback goes on a fidelity form (a check that steps were followed) that routes to the lead supervisor first. The lead can coach the resident before the message lands on a peer.

Sequencing the Test Content Outline Across Six Quarters

The Residency takes about five to six quarters. School takes about two years. So most residents finish their hours near the end of their degree. The team maps the Test Content Outline (the official list of exam topics) onto those quarters. It is not a strict syllabus. It is a roadmap for what to cover when.

Quarter one sits in level one and stays with the basics, such as measurement and ethics. Quarters two and three move into level two. Residents go deeper into concepts and the philosophy behind the work. They take on early behavior change procedures. Quarter three adds more advanced measurement and more assessment.

The later quarters are what the team calls go time. This is level three. Residents dig into experimental design (planned studies that test what works), picking interventions, deeper ethics, and supervision and management. Quarter six is held back as a makeup quarter. Some residents work part time and need the extra room. Others use it to fill gaps their quarterly ratings turned up. The map itself came from a BCBA problem. Supervisors were not always sure what to cover with a resident in a given quarter.

Because there's so much content, right?

From the talk — Sarena Cambrea

The Documentation Set That Makes Progress Visible

The paperwork here is not busywork. It is what makes progress visible to the next supervisor. New residents get a plain language guide that answers one question: I just started my fieldwork, now what? The supervision contract gets signed right away with the primary supervisor. Residents also collect signatures from the other BCBAs, so their hours count as they work across teams.

Each resident gets a fieldwork binder. It holds the ethics code and the exam content outline. It also holds a log that splits restricted from unrestricted hours (time spent on BCBA level tasks). The binder also holds CASP provider guidelines (standards for ABA providers), coding guidance, and copies of the forms they will use. They set up an hours tracker too. The BACB sheet, an in house Excel version, or their own build all work. Deadlines are tight on purpose, so sign offs land in the right month.

The monthly supervision checklist is the workhorse. Residents log shadowing sessions with dates. They check off the activities they did. They note the articles they read and why they read them. They list meetings attended and staff trainings they ran. They also show up with questions ready. Group supervision runs monthly. The topics come from a short poll sent out ahead: case talks, ethics talks, round table time.

Two more pieces round out the set. A resident timeline shows the whole path from day one, with room to flex. An activity library holds ready made unrestricted tasks, all built off the exam content. Tasks range from reading graphs and spotting trends to full treatment plans and OBM projects (using ABA on work systems). The lead picks tasks with the resident's current BCBA and ties them to real cases. That cuts the load on BCBAs, who no longer invent work from scratch. It also keeps learning going when a supervisor is out.

The permanent products things have been really, really helpful. especially as we rotate supervisors.

From the talk — Sarena Cambrea

Quarterly Self-Ratings and the Soft Skills Nobody Teaches

Check ins happen every quarter, not just at the end. Residents rate themselves on the exam content with a 1 to 4 scale. One means they can define it. Two means they can give examples and non-examples. Three means they can show it. Four means they can teach it to someone else.

The ratings go to the resident, the current supervising BCBA, and the program lead. Gaps then drive what gets trained in the next quarter. It is a cheap way to keep growth moving in a straight line. It also tells a new supervisor where to start on day one of a rotation.

The second rating sheet may matter even more. Each quarter the supervising BCBA scores soft skills on that same 1 to 4 scale. The list covers talking with people, emotional smarts, people skills, and how they carry themselves at work. It also covers flexibility, critical thinking, leadership, mentorship, time use, and cultural humility (respect for a family's culture). The exam content does not prepare anyone for those parts of the job.

The Residency trains the business side too. Residents learn codes, payers, and what a denial means. They learn where care gets blocked and how to speak up for clients. They practice how to train RBTs (certified aides who run sessions). They work through hard talks with unhappy parents. They also talk about resilience, since much of this job sits outside anyone's control. That is the part that burns new BCBAs out.

I really will rarely score you as a four.

From the talk — Sarena Cambrea

Shadowing Rules and the Program Change Proposal

Watching is the easy part, and that is the problem. The team wrote shadowing rules so observation does not become the whole job. Sessions are capped at one hour, with a purpose set in advance. Residents log no more than two per week without permission.

A few guardrails keep the lines clean. Residents only observe clients their current supervising BCBA oversees. They watch instead of running programming during that session, and the programming can come later. They also do not coach the aide on behavior or programming unless the supervising BCBA is present and on board. A well meant tip from a learner can land wrong.

Every shadowing session ends with a program change proposal (a written case for one change). The form asks for the thinking behind it. What did the resident see? What did they look up on that case? What would they add, change, or drop, and why? The supervising BCBA reads it and writes back. Sometimes the answer is yes, go. Sometimes it is a reason the change is wrong, or the timing is off, or a better measure exists. Supervised case changes get the same treatment. Over two years that builds a long feedback loop on clinical judgment.

We have to observe. And then also think about, well, what's next?

From the talk — Sarena Cambrea

Rotating Supervisors and Working Both Sites on Purpose

Residents switch to a new supervising BCBA every quarter. They also have to work at both sites. That sounds like a lot of churn for one trainee. The payoff is range. Every supervisor brings different strengths, styles, and history. A resident who rotates through several supervisors builds several models to learn from.

The two sites split by age. One serves kids ten and under, and the other serves teens and older clients. Working with the older group shows a resident where the younger ones are headed. It also widens the set of assessments and methods they have touched. The practice runs a school based homeschool co-op as well, with speech, OT (occupational therapy), and a teacher. Residents sit in on IEP meetings (a school plan for one student) and family guidance sessions. That is real practice on a multidisciplinary team (staff from speech, OT, and school).

Rotation only works if the time exists. Residents get set weekly programming time, and their schedules get cleared as much as the day allows. In trade, they float. When a staff member calls out, the resident covers the session. The team does not run formal agreement checks across supervisors. Instead, the BCBAs meet weekly and the lead meets each resident monthly. The written record travels with the resident, so the next supervisor can see what came before.

So we made sure that every resident works under a different BCBA.

From the talk — Sarena Cambrea

Incentives, Hiring, and What Happens After the Hours Are Done

The team treats the whole Residency as a two year interview. Both sides are on the hook. The practice owes a real program, and the resident owes real effort. Supervision is handled in house, and no contract binds a resident to stay. If someone is unhappy or needs to move home, holding them in place helps nobody. What they learned goes with them to the next practice. Raises are tied to coursework progress, not to holding the resident seat. Supervisees move up as they move through school.

Passing the exam makes someone eligible, not hired. Near the end, the directors and the candidate sit down for a two way interview. They talk about what the BCBA role looks like here, plus values, teamwork, hours, and skill. The candidate asks questions too. Little in that room is a surprise, because the quarterly ratings have been saying it for two years. The call gets made before the exam, so a passing candidate knows a job is waiting.

Some residents finish their hours while school is still going. They go back to the aide role, and someone from the waiting list rotates in. They stay a resource to their peers and still pick up higher level tasks. That trade is named out loud from the first day, which is why it holds.

New BCBAs then get a mentor for the long haul. The first year is mapped by quarter. Much of quarter one goes to direct work while credentialing (getting cleared by insurance plans) drags on. Mentors meet weekly during this time. Quarter two stays weekly with more room to run. Quarter three moves to every other week, and quarter four shifts toward monthly. After that, the mentor stays available without standing meetings.

eligibility does not guarantee a job so passing the BCBA exam it makes someone eligible to apply but it doesn't guarantee a promotion or raise or a new position

From the talk — Sarena Cambrea